Provider Demographics
NPI:1932698792
Name:CORDES, BRYAN (LCSW)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:CORDES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 THAYER ST APT C42
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1046
Mailing Address - Country:US
Mailing Address - Phone:908-451-4327
Mailing Address - Fax:
Practice Address - Street 1:295 MADISON AVENUE
Practice Address - Street 2:SUITE 707
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:908-451-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0852211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical